How to Lodge a Complaint against a Health Insurance Company?

When we buy a health insurance policy from a health insurance company, we expect some services and benefits from the insurer as mentioned in the policy papers. However, if we do not receive the facilities as promised, we become unsatisfied with the policy provider. If you feel that you are not satisfied with your insurance company, you can approach the IRDAI or Insurance Regulatory and Development Authority of India to find a solution. You can escalate the issue in various ways by means of an IRDA complaint.

There is a certain Turn Around Time (TAT) that the IRDAI has allowed for different services provided by insurance providers. As per rule, the turnaround for life insurance and general insurance is maximum depending on the kind of issue or grievance that is required to be addressed.  If the insurer does not comply with the TAT to resolve a particular issue, the policyholder can seek interference by the IRDAI to resolve the same.  However, if the policyholder escalates the dispute to IRDAI, the association is required to resolve it with the insurer. Further, if any enquiry is needed regarding the issue, the insured can move towards the consumer court.

Process to Lodge a Complaint Against your Health Insurer with IRDAI

Below is the process to lodge a Complaint against a Health Insurance Company:

• The first step in the direction of lodging a grievance against a health insurer is to visit the office of Grievance Redressal of your insurer
• Once you are in the office, you can submit a complaint in writing with the related documents
• The office will offer a written acknowledgement stating the date of lodging the complaint
• In most cases, the insurer is expected to solve the issue within a time frame of 15 days
• However, if they fail to resolve the issue within the stipulated time, it is forwarded to the IRDAI

Steps to Lodge a Complaint Against your Health Insurer with IRDAI

Below are the steps:

If you want to lodge a complaint with the IRDAI against your insurer, you must contact the IRDAI’s Grievance Redressal Cell. This cell is a part of the Consumer Affairs Department of the association and one can submit the complaint via IRDA Complaint mail id or calling the customer services.  IRDAI offers an Integrated System of Grievance Management that monitors the complaint after it is lodged. The insured can get in touch with the association via mail or fax.

Below is the maximum TAT for particular grievances associated to certain services of the health insurers:

Hence, to initiate the process you need to contact the helpdesk of your insurer to resolve your issue. In case the TAT is over and the issue still persists, you may escalate the problem to IRDAI.

Here are the contact details of the top health insurance companies’ Grievance Cell:

Contact Details of Grievance Cell of Health Insurers

Contact Details for Grievance Redressal Cell of the Consumer Affairs Department for IRDA complaint:

Channels for Lodging a Complaint:

You can lodge a complaint against your insurance provider via three main channels – the Insurance Ombudsman, the Integrated Grievance Management System and the Consumer Court.

1. Insurance Ombudsman:

Insurance Ombudsman is the first channel in case you want to escalate an issue pending with your insurance provider.

Following are the conditions to file a complaint with the Insurance Ombudsman channel:

• If your insurer rejects your claim partially or wholly
• If the insurer has not issued a policy even though you have made the premium payment
• If there is a delay in settlement of claim
• If there is a disagreement concerning payable and paid premiums
• If there is a difference of opinion concerning the terms and conditions mentioned in the Policy papers.

2. Integrated Grievance Management System:

This is an online channel introduced by IRDAI. Here, the policyholder who wants to lodge a complaint against the insurer may escalate the issue. This system allows the complainant to register and track the progress of the complaint online.

Further, this system offers a unique ID to the complaints and dispenses them to the particular departments to get resolved. This way monitoring the complaint becomes easy and also ensures efficient resolution of the issue in a proper system.

3. Consumer Court:

Lastly, if the issue persists and is unresolved, the complainant can move to consumer court, which handles grievances related to health insurance separately. You can submit your complaint at the consumer forum complaint email id.